Gianni Turcato, Arian Zaboli, Alessandro Cipriano, Paolo Ferretto, Fabrizio Lucente, Lucia Filippi, Michael Maggi, Massimo Marchetti, Christian Josef Wiedermann, Lorenzo Ghiadoni
{"title":"中级监护病房：减少重症监护病房入院的有效选择——一项前瞻性队列研究。","authors":"Gianni Turcato, Arian Zaboli, Alessandro Cipriano, Paolo Ferretto, Fabrizio Lucente, Lucia Filippi, Michael Maggi, Massimo Marchetti, Christian Josef Wiedermann, Lorenzo Ghiadoni","doi":"10.1007/s11739-025-04083-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Critically ill medical patients from the Emergency Department (ED) are admitted either to general wards or the Intensive Care Unit (ICU). This binary allocation may lead to suboptimal management of non-intensive critical patients, increasing ICU overcrowding. Intermediate Care Units (IMCUs) could be an effective alternative, but their ability to reduce avoidable ICU admissions remains unclear.</p><p><strong>Aim: </strong>To evaluate whether an IMCU could effectively manage acutely ill patients with potential ICU treatment needs and to assess its role in reducing avoidable ICU admissions while maintaining patient outcomes.</p><p><strong>Methods: </strong>This prospective observational study (January-December 2024) was conducted at the IMCU of Alto Vicentino Hospital, Santorso, Italy. All acute patients admitted to the IMCU were included, excluding step-down ICU transfers. Clinical characteristics, disease severity, and organ dysfunction were recorded. Patients were classified based on their potential ICU treatment need, and ICU exclusion criteria were documented. Primary outcomes were ICU transfer due to IMCU failure and 30-day mortality.</p><p><strong>Results: </strong>Among 678 patients, 40.4% (274/678) had potential ICU treatment needs. Overall, 92.6% had organ failure, and 41.3% had multiple organ dysfunctions. IMCU management avoided ICU admission in 203 of 274 patients (79.9%). ICU transfer rate was 6.9% (47/678), and 30-day mortality was 12.8% (87/678). Among ICU-potential patients, mortality was 16.4% (45/274), decreasing to 11.4% (27/236) in those without ICU exclusion criteria.</p><p><strong>Conclusions: </strong>These findings suggest that IMCUs may serve as an effective alternative for managing critically ill non-intensive care patients, reducing avoidable ICU admissions while maintaining clinical outcomes.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8000,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Intermediate care units: an effective alternative to reduce intensive care unit admissions-a prospective cohort study.\",\"authors\":\"Gianni Turcato, Arian Zaboli, Alessandro Cipriano, Paolo Ferretto, Fabrizio Lucente, Lucia Filippi, Michael Maggi, Massimo Marchetti, Christian Josef Wiedermann, Lorenzo Ghiadoni\",\"doi\":\"10.1007/s11739-025-04083-2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Critically ill medical patients from the Emergency Department (ED) are admitted either to general wards or the Intensive Care Unit (ICU). This binary allocation may lead to suboptimal management of non-intensive critical patients, increasing ICU overcrowding. Intermediate Care Units (IMCUs) could be an effective alternative, but their ability to reduce avoidable ICU admissions remains unclear.</p><p><strong>Aim: </strong>To evaluate whether an IMCU could effectively manage acutely ill patients with potential ICU treatment needs and to assess its role in reducing avoidable ICU admissions while maintaining patient outcomes.</p><p><strong>Methods: </strong>This prospective observational study (January-December 2024) was conducted at the IMCU of Alto Vicentino Hospital, Santorso, Italy. All acute patients admitted to the IMCU were included, excluding step-down ICU transfers. Clinical characteristics, disease severity, and organ dysfunction were recorded. Patients were classified based on their potential ICU treatment need, and ICU exclusion criteria were documented. Primary outcomes were ICU transfer due to IMCU failure and 30-day mortality.</p><p><strong>Results: </strong>Among 678 patients, 40.4% (274/678) had potential ICU treatment needs. Overall, 92.6% had organ failure, and 41.3% had multiple organ dysfunctions. IMCU management avoided ICU admission in 203 of 274 patients (79.9%). ICU transfer rate was 6.9% (47/678), and 30-day mortality was 12.8% (87/678). Among ICU-potential patients, mortality was 16.4% (45/274), decreasing to 11.4% (27/236) in those without ICU exclusion criteria.</p><p><strong>Conclusions: </strong>These findings suggest that IMCUs may serve as an effective alternative for managing critically ill non-intensive care patients, reducing avoidable ICU admissions while maintaining clinical outcomes.</p>\",\"PeriodicalId\":13662,\"journal\":{\"name\":\"Internal and Emergency Medicine\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.8000,\"publicationDate\":\"2025-08-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Internal and Emergency Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s11739-025-04083-2\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Internal and Emergency Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11739-025-04083-2","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
Intermediate care units: an effective alternative to reduce intensive care unit admissions-a prospective cohort study.
Background: Critically ill medical patients from the Emergency Department (ED) are admitted either to general wards or the Intensive Care Unit (ICU). This binary allocation may lead to suboptimal management of non-intensive critical patients, increasing ICU overcrowding. Intermediate Care Units (IMCUs) could be an effective alternative, but their ability to reduce avoidable ICU admissions remains unclear.
Aim: To evaluate whether an IMCU could effectively manage acutely ill patients with potential ICU treatment needs and to assess its role in reducing avoidable ICU admissions while maintaining patient outcomes.
Methods: This prospective observational study (January-December 2024) was conducted at the IMCU of Alto Vicentino Hospital, Santorso, Italy. All acute patients admitted to the IMCU were included, excluding step-down ICU transfers. Clinical characteristics, disease severity, and organ dysfunction were recorded. Patients were classified based on their potential ICU treatment need, and ICU exclusion criteria were documented. Primary outcomes were ICU transfer due to IMCU failure and 30-day mortality.
Results: Among 678 patients, 40.4% (274/678) had potential ICU treatment needs. Overall, 92.6% had organ failure, and 41.3% had multiple organ dysfunctions. IMCU management avoided ICU admission in 203 of 274 patients (79.9%). ICU transfer rate was 6.9% (47/678), and 30-day mortality was 12.8% (87/678). Among ICU-potential patients, mortality was 16.4% (45/274), decreasing to 11.4% (27/236) in those without ICU exclusion criteria.
Conclusions: These findings suggest that IMCUs may serve as an effective alternative for managing critically ill non-intensive care patients, reducing avoidable ICU admissions while maintaining clinical outcomes.
期刊介绍：
Internal and Emergency Medicine (IEM) is an independent, international, English-language, peer-reviewed journal designed for internists and emergency physicians. IEM publishes a variety of manuscript types including Original investigations, Review articles, Letters to the Editor, Editorials and Commentaries. Occasionally IEM accepts unsolicited Reviews, Commentaries or Editorials. The journal is divided into three sections, i.e., Internal Medicine, Emergency Medicine and Clinical Evidence and Health Technology Assessment, with three separate editorial boards. In the Internal Medicine section, invited Case records and Physical examinations, devoted to underlining the role of a clinical approach in selected clinical cases, are also published. The Emergency Medicine section will include a Morbidity and Mortality Report and an Airway Forum concerning the management of difficult airway problems. As far as Critical Care is becoming an integral part of Emergency Medicine, a new sub-section will report the literature that concerns the interface not only for the care of the critical patient in the Emergency Department, but also in the Intensive Care Unit. Finally, in the Clinical Evidence and Health Technology Assessment section brief discussions of topics of evidence-based medicine (Cochrane’s corner) and Research updates are published. IEM encourages letters of rebuttal and criticism of published articles. Topics of interest include all subjects that relate to the science and practice of Internal and Emergency Medicine.
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